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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infection or dehiscence of the tracheal anastomosis remains a dreaded and almost always fatal complication following heart-lung transplantation (HLTX). A technique of pericardial flap-plasty combined with application of fibrin sealant and topical antibiotics was developed and applied in three patients undergoing HLTX. The method allows for safe protection of the anastomosis even in the presence of severe ischemia and partial necrosis of the donor trachea at the same time avoiding laparotomy for mobilization of the omentum.
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PMID:Pericardial flap-plasty for protection of the tracheal anastomosis in heart-lung transplantation. 252 19

Infection following breast implants is an uncommon event. This is somewhat surprising, since the human breast is not a sterile anatomical structure. The flora found in the breast are derived from the nipple ducts and closely resemble those of normal skin. These organisms, predominantly S. epidermidis, may in some cases be responsible for firmness secondary to capsular contracture. Treatment of the periprosthetic infection usually involves implant removal, but salvage by systemic antibiotics is sometimes possible. Atypical mycobacteria are very rarely the cause of infection, but can be extremely difficult to eradicate when involved. Toxic shock syndrome has been reported to occur following breast implants and is a life-threatening problem requiring immediate removal of the implant. It may be significant that in some cases with effusion and infection occurring many months or years after implant placement, there has been a preceding event such as a laryngitis or flu-like illness. This suggests the possibility of a bacteremia being involved in the causation of the infection. If this were the case, then these patients should be handled in a fashion similar to those with prosthetic heart valves. Accordingly, in our own practice, we advise that penicillin "V" be given beforehand when a patient with breast implants is to have any dental procedure. It must be stressed that there is no statistical or scientific proof at the present time that this is of any value. In conclusion, when dealing with these large foreign bodies, absolute sterility is essential, and excellent surgical technique to obviate hematoma and the occurrence of tissue ischemia is mandatory. Evidence of severe infection necessitates implant removal, but in less severe cases a trial of intravenous antibiotics is permissible. Having removed an implant, further insertion should be deferred, preferably for 6 months. If the new implant can be placed in a different plane, that is, submuscular, this is desirable. Exposed implants can be salvaged but this requires considerable judgment and one should be prepared for re-exposure or frank infection.
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PMID:Infections in breast implants. 266 82

Seven-day-old mice were infected orally with murine rotavirus (EDIM) and regions of the gut examined at 24 h intervals up to 7 days by electron microscopy. Structural changes were correlated with data on viral antigen production, thymidine kinase activity, and clinical signs of diarrhea. No pathological changes were detected in the colon. Infection and structural damage were confined to the small intestine, with middle regions showing the most pronounced changes. Constriction of villus bases, edema of the lamina propria, and vacuolation of enterocytes occurred at 24 h postinfection (PI), i.e., before evidence of major virus replication. Transient villus atrophy occurred at 48 h PI. Recovery of villus length was evident by 72 h PI accompanied by evidence of marked enterocyte replication at villus bases. Many enterocytes were damaged with little evidence for the presence of virus particles. By 96 h PI, villi had almost recovered from infection although some enterocytes were still damaged; no virus particles were detected in these cells. A second phase of villus damage and edema of the lamina propria occurred at 120 h PI; the pathology resembled that at 24-48 h PI. By 144 to 168 h PI, recovery of the mucosa from infection was virtually complete. We suggest that many of the pathological features following rotavirus infection result from rotavirus-induced ischemia of villi and that diarrhea results from malabsorption of fluid by damaged villi and hypersecretion of ions released from increased numbers of dividing cells at villus-crypt borders.
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PMID:An electron microscopic investigation of time-related changes in the intestine of neonatal mice infected with murine rotavirus. 283 83

Controlled hypotension reduces blood loss during defined major surgical procedures, which in turn will minimize transfusion needs and thereby the risks of transmission of infectious diseases. There is no evidence that hypotension below 8 kPa (60 mmHg) (MAP) is associated with better blood-sparing effects than a more moderate hypotension, but it will probably increase the risk of cardiovascular complications. Therefore, controlled hypotension, being a sophisticated technique, requires handling by an experienced anesthetist well aware of contraindications and the need for adequate monitoring for prevention of tissue ischemia. Large randomized and prospective studies are still warranted, especially for further evaluation of the risk-benefit with controlled hypotension.
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PMID:Hypotensive anesthesia and blood loss. 306 88

The acute scrotum remains a difficult clinical challenge because of numerous etiologies including inflammatory processes, testicular torsions, traumas, and tumors that can justify early surgery. Ultrasound study appears to be the imaging modality of choice to confirm the clinical assessment. We reviewed 825 scrotal scans performed with high-resolution scanners; 283 were considered pathologic and classified as follows: 27 tumors (9.5%), 21 traumas including torsions (7.4%), 142 infectious diseases (50.1%), 99 dystrophic diseases (29.2%), and 16 miscellaneous (5.6%). Acute scrotal pain was the only symptom in 83 cases (29.3%). In this paper, we emphasize the different roles of ultrasound depending on the initial clinical presentation, which determines the clinician's questions. In the typical cases, ultrasound has a major role in the prognosis, as it allows evaluation of the severity of the lesions. On the other hand, in atypical cases, ultrasound has a decisive role in planning the management, which will be immediate surgery when sonographic findings highly suspicious for testicular torsion or acute ischemia of the testis are found. Based on our experience, we believe that ultrasound is a highly reliable modality for guiding medical or surgical treatment of an acute scrotum.
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PMID:Ultrasonography of the acute scrotum. 310 22

A variety of infectious processes produce cutaneous and soft-tissue involvement of the lower extremities. Patients with conditions leading to ischemia and devitalized tissues, and those with diabetes mellitus are predisposed to developing these infections. The signs and symptoms and bacteriology of many of these infections may overlap, leading to confusion in diagnosis and subsequent management. Very often the progression of some of these infections is rapid and life-threatening, although mutilating-type infections are not uncommon. Optimal management requires a multidisciplinary approach, with the surgeon, microbiologist, pathologist, internist, and infectious disease specialist working in close cooperation with each other.
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PMID:Infections involving the skin and soft tissues of the lower extremities. 355 52

Complications and morbidity associated with vascular graft infections continue to be a major clinical problem. Ischemia and gangrene are consequences of limb circulation failure, especially in extra-anatomic, occluded and infected bypass prostheses. Infection of the tissue bed of such prostheses should be prevented. When it occurs, the use of the contralateral obturator foramen represents an alternative route in cases in which it is impossible to use the ipsilateral vessels. Prosthetic crossover reconstruction through the obturator foramen may be considered a safe and effective solution for patients with a limb threatening infection of the extra-anatomic graft and a damaged blood supply.
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PMID:Cross over ileo-popliteal bypass through the obturator foramen: an additional route for extra-anatomic limb blood supply. 383 42

Postirradiation alteration of oral flora is well documented in the literature. Infection as a complication leading to partial or complete loss of a flap used to reconstruct a defect in the oral cavity is a worrisome outcome. We describe how a flap that was judged clinically to be viable became overwhelmingly infected with the Klebsiella oxytoca, an oral cavity pathogen encountered in this patient following irradiation. Local and systemic changes led to detachment of the flap. This complication may be explained, in view of the absence of venous congestion or arterial ischemia both clinically and pathologically, by the proven contamination of the flap by the Klebsiella pathogen. Local factors resulted in lower resistance and subsequent overwhelming infection. Discussion of the case, review of pertinent literature, and proposed solutions are presented.
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PMID:Postirradiation flap infection about the oral cavity. 688 66

There is great concern about the health effects of cocaine use during pregnancy. Cocaine alters maternal physiology and crosses the placenta to interact with fetal tissues including the brain. Neurotoxicity, defined as structural and/or functional changes which result in a neurobehavioral deficit, is not unequivocally documented in the human. It is difficult to ascertain duration, intensity and frequency of cocaine exposure in humans as well as the effects of multiple drug use, poor nutrition, lack of prenatal care, lead exposure and infectious diseases. In addition, plasticity of the central nervous system makes the postnatal environment as important as the intrauterine milieu for the developing organism. Animal studies, which allow quantitation of drug exposure and reduction of confounding variables, suggest several possible mechanisms for neurotoxicity induced by cocaine or its active metabolites. The possible mechanisms include: alteration of sodium channel and monoamine transporter development, release of epinephrine from the adrenal medulla with subsequent hyperglycemia, vasoconstriction with subsequent hypoxia and decrease of nutrient supply, calcium ion chelation, superoxide formation or infarction following repeated ischemia and reperfusion, enzyme inhibition, reduced neurotrophic activity, altered gene expression and plasma membrane changes. Alterations in the above parameters may cause acute and reversible effects as well as chronic and permanent effects. Not all alterations in structure and function are deficits, and no single mechanism may explain a given alteration.
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PMID:Potential mechanisms of cocaine-induced developmental neurotoxicity: a minireview. 760 37

Infection of the femoral artery together with limb acute ischemia represent for the vascular surgeon a challenging condition to manage. To solve this complicated vascular problem in the groin, the obturator foramen bypass has been described as an alternative procedure for ischemic limb salvage. The authors report their experience with a diabetic patient admitted in critical conditions with an ischemic leg and sepsis of the femoral area due to an infected extra-anatomical crossover femoro-femoral bypass complicated by hemorrhagia and which was partially removed in another Hospital. Limb revascularization was achieved by an obturator foramen PTFE expanded iliopopliteal bypass. The residual infected prosthesic stump was, thereafter, removed from the groin wound. The post-operative period was uneventful and the patient was discharged in the XIII post operative day. At follow-up, latest control at 10 months (July 1993) documented a patent graft and an ankle pressure index > 1. This experience, and a review of the literature, confirm the validity of the obturator foramen bypass as a route of choice for infected femoral artery and ischemic limb salvage.
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PMID:[Obturator foramen bypass for revascularization of the leg with infection of the femoral area. A clinical case]. 761 52


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